Acupractitioner21 is the sequel to the underground hit Acustudent21, from one of the periods when I was training in Chinese medicine. This blog will focus on Classical Chinese Medicine, CCM, the old system, and on what it´s like to practice acupuncture in the West in the 21st century. The name might have changed, but like everybody in old Chinese medicine, I am still a student.

söndag 22 januari 2012

Acupuncture points – if you want to use them for full effect, you have to be able to feel them, and how you make friends with acupuncture points in your practice

First of all, let´s look again at one of my favourite quotes from one of my teachers, Dr Wang Juyi:

”When I first began studying, I believed that points were just measured places on the body that might be located on a cadaver or in an anatomy text. Also, I believed that all points on the body were roughly the same: that they are all openings between the various structures of the body. Later, I began to appreciate subtle differences among the points. Some have more qi or more blood, some have less. In some places the type of qi is different than in others. Importantly, the exact nature of qi sensation that should be generated from each point varies, and should be varied depending on the desired effect. Each point actually has its own nature or personality. Once I began to truly note these differences among the points on my patientes, I became more and more interested in the classical point categorizations. It is from here that I began my explaration of the source, collateral and five transport points.

In fact, after many years, I now think of many of the points on the body as old friends. I know what they are like, what their strengths and weaknesses are, and when to call on them for help. When you get to know the points in this way, treating in the clinic is kind of like waking good friends from a slumber – gently prodding the points to wake them up and send them on their way. Also, as I´ve said before, some of the points are like jacks-of-all-trades, friends that you might call on to help with a wide variety of projects. Other points have very specific strengths and should be used in more specific cases. The points, to me, really do seem to have these different personalities.”

Touch. For many who work with acupuncture it is quite easy to miss. So much focus ends up at putting needles into the patient, or even putting many needles into the patient, in some strange idea that if they get many needles they will feel that the treatment works better (often it is the other way around, the fewer needles, the higher effect). The skill and care of touch is often lost on the way, without realizing that losing it actually decreases the effect of the treatment too.

The way a practitioner of acupuncture uses touch will have big influence on their treatment. There are so many ways to touch someone. Part of the power of something seemingly as simple as touch is that when someone touches you, they affirm your existence. When you touch someone, you both affirm the link between two beings and help the person feel seen: someone touches me, therefore I exist. So many people in our day and time don´t feel seen at all, so even something so simple can have a huge effect.

Good bodywork courses should include techniques for different intents for touch as this is part of the basic work in the field. In China, the skills of touch within Chinese medicine seems to have had a bit of a dip over the past century. Much more of the tactile diagnostic skills have remained within Japanese acupuncture. Dr Wang, quoted at the beginning of this post, is one of the innovators of tactile diagnostics in his system of channel palpation, something he consciously researched and deepened over 45 years as acupuncture doctor in chinese hospitals.

There is the purely technical aspect of skill in this, and then there are emotional and mental techniques, the intent, that will increase treatment effects and be able to change the mood of the patient before a needle is even inserted. Both these will also clearly affect the needling skills a practitioner has and the effect of the treatments they give.

As an aside, there is a frequent problem in Chinese acupuncture doctors coming to the West and needling Westerners in the same way as they would treat patients in China; most Chinese are used to acupuncture, and treatments can be quite powerful and hard. In the West, people aren´t used to acupuncture, and the level of power that can be done in treatments has to be downscaled to for a patient here. The more they work in the West they more they adapt, but doctors who just have come over often use treatments that are much too strong for Westerners in general.

If we now look at this old post from my blog:

A saying by Zhang Zhongjing:

"The skilful doctor knows by observation, the mediocre doctor by interrogation, the ordinary doctor by palpation."

Zhang Zhongjing wrote the Shang Han Lun, the Treatise on Cold Disorders during the Han dynasty, 200 AD. The book is one of the Chinese medical classics. Zhang himself is known for his virtous life and his passion for becoming ever more skilled at Chinese medicine so that he could serve his patients better. In the Preface to the Shang Han Lun, he exhorts his contemporary doctors to work harder, saying that many of them are criminally lazy in their work 1800 years ago.

Observing (wang zhen) is the highly trained and precise method of looking at a patient to see their health. The more skilled a doctor becomes over the years, the more he or she sees within seconds of meeting a patient, or seeing a shift in a patient since last time. This is trained (like I talked about in a previous post about airports) and trained and trained. This blends with the skill called Tingjin, or Listening Energy, of the Internal Martial Arts of Baguazhang, Taiji, and Xingyi, but in chinese medical practice it inhabits the middle ground between martial skills and the tingjin that a Daoist adept would use to read much more in a person than that which is visible.

Interrogation is usually a little more mildly called Asking (wen zhen) when translated. Here, the doctor asks questions that elicit specific views into the patients health. There is a youtube clip of Peter Deadman, a well-known acupuncturist, talking about seeing one of his teachers, a laoyisheng, a senior doctor, diagnose patients. He would usually ask them one, maybe two questions while taking their pulse, then treat with a very small number of needles and get an incredible effect. But that doctor had been actively training and practicing his skills for 40 years.

Palpation, or touching, (qie zhen), covers both taking the pulse and sometimes touching and diagnosing a patient´s body, organs and skin. The pulse is a tool that the doctor uses to verify information already gained through looking and asking. This later transfers into the ability to feel points through touch, a skill that is getting more and more lost in acupuncture today, as it depends on the doctor or practitioner having good, stable qigong-skills, and these are rarely taught nor emphasized today. Acupoints move, both sideways and in depth, so knowing only a physical placement - ”In the center of the flesh between the 1st and 2nd metacarpal bones, slightly closer to the 2nd metacarpal bone. If the transverse crease of the interphalangeal joint of the thumb of one hand is lined up with the margin of the web between the thumb and the index fingers of the other hand, the point is where the tip of the thumb touches” - for Large Intestine 4, Hegu, placed in the middle of what is called Hukou or the Tiger´s Mouth in qigong and the Internal Martial Arts, is not enough. Hegu is a point that has been quite popularized and misunderstood in the West. Knowing the language for where it is in physiological terms doesn´t mean the practitioner will feel where the point actually is and truly activate it with a needle.

With years of training and clinical practice, a skilled doctor picks up most of the information with the trained skill of a actively looking at the patient. Then this is verified by specific questions, tounge, and verified yet again in depth by carefully taking the pulse. All are techniques aimed at getting a diagnostic view of the organic system and organic change that is a living, breathing, human being.

Human beings are alive. Both our bodies and minds live. Points in our living body move, ever so slightly, but they move. The watered down versions of acupuncture that have been spread in the West often base their needling on charts with ”x marks the spot”. In actual fact, to really give acupuncture its full treatment ability, 1) the practitioner needs to be able to both diagnose, then 2) feel where the point is, 3) feel the area, the point, points around it, sometimes feel along one or several meridians to see different diagnostic signs, 4) wake the point up through some light pressure and massage (and sometimes the meridian too) and then 5) have good needle skills on top of that. Then, 6) the intent used when needling also increases the effect – a practitioner who puts a needle into a patient like they´re a piece of meat will often shock them and make their nervous system tense as well as create pain. Good acupuncture very rarely creates any pain at all.

On top of this is 7) the qigong- and meditation-skills of the practitioner. Stable, long-term qigong- and/or meditation-practice will again increase the effect of treatments. In Western medicine the individual skill of a doctor can affect the outcome a bit, but not all that much; in Chinese medicine, the individual skill of a practitioner or doctor can have a huge effect on the treatment and on the patient´s health. An interesting thing to remember is that most of the legendary doctors in Chinese history have also been Daoist masters or adepts.

2, 3, and 4 all increase diagnostics and treatment effect. One reason for this is that they wake up the qi in the point, the area and the meridian - the entire patient. If this already is done, the needling will be much more effective. The skills in touch is used in 1 as well, but that depends a lot on which school of Chinese medicine is used – some teachers use palpation skills, some don´t at all, and the level at which they do it vary over a wide scale. Japanese acupuncture is more at home with it and has a good system in place for most practitioners.

Dr Wang´s quote, which we started this post with, gives a sense of what a skilled and very long-time practitioner of acupuncture gets: a friendly relationship with the points. By this stage, the diagnostic ability of the practitioner is often at such a high level that just one, two, three or four points can treat the very core problems of a patient, yet work with that person in such a way that the entire system gently opens and gets balanced instead of forcing it to do so – very much in the concept of ziran, following the natural flow, one of the principles of Daoism. It´s at that level we get close to – or reach – the legendary one-needle doctors in Chinese medical history.

”In fact, after many years, I now think of many of the points on the body as old friends. I know what they are like, what their strengths and weaknesses are, and when to call on them for help. When you get to know the points in this way, treating in the clinic is kind of like waking good friends from a slumber – gently prodding the points to wake them up and send them on their way. Also, as I´ve said before, some of the points are like jacks-of-all-trades, friends that you might call on to help with a wide variety of projects. Other points have very specific strengths and should be used in more specific cases. The points, to me, really do seem to have these different personalities.”